Healthcare Provider Details

I. General information

NPI: 1215449590
Provider Name (Legal Business Name): UNIVERSITY OF KENTUCKY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2017
Last Update Date: 11/07/2021
Certification Date: 11/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UK COLLEGE OF DENTISTRY 770 ROSE STREET, MN328
LEXINGTON KY
40536
US

IV. Provider business mailing address

770 ROSE ST # D103
LEXINGTON KY
40536-0297
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-3368
  • Fax: 859-257-5859
Mailing address:
  • Phone: 859-323-5935
  • Fax: 859-257-5859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: VICKI RIDDELL
Title or Position: ASSOC DEAN FINANCE ADMIN
Credential:
Phone: 859-323-5935